Exercise

As professionals, we deal with a wide range of conditions for joints and soft tissue problems. We all work with different methods, approaches and principles. At the end of the day, the truth is, we are all solution driven and we all work to make lives better.

We often come across with words like mobility and flexibility throughout our education and training. Whether you are a physical therapist, an osteopath, fitness trainer or a massage therapist. From a professional perspective, when we look at problems with movements, we immediately think of all the tight structures that are causing any restriction in the range of motion (ROM).

Now, the big question is – is this lack of ROM a mobility problem or a flexibility problem?

Let’s make this clear so that we can consider what’s contemporary for best clinical practice.

Flexibility – “Oh this looks very tight, let me stretch this for you!”

We often use the word “flexibility” too quickly because it is a very convenient and quick way to communicate with a novice. When you say that the lack of ROM is because of tightness in the muscles indicating a flexibility issue, it implies that stretching all the tight tissues can fix the problem. However, are we really dealing with the underlying issue here?What we are doing is not addressing the real problem AND only treating the symptoms. What if there is a misalignment in the joints causing impingement or some sort of joint restriction?

What are we missing?

The term ‘flexibility problem’ for all joint restrictions would actually mean that we are looking at the problem from only one perspective. Thus using the word ‘flexibility’ shows a great lack of understanding of the injury itself.

When injured, why do we get tight muscles and soft tissue structures?

Post-injury your muscles involuntarily contract to safeguard the injured site. Contracted muscles get fatigued causing soreness and pain. They also pull on bones compressing joint structures. So over-tight muscles now cause over-tight joints. Tight joints lead to stiffness and can cause more pain. Long-term compression of these joints leads to cartilage damage and joint restriction in ROM. Therefore, if you are only looking at the flexibility problems of the muscles and have been stretching them, you might be favoring the injury and causing more damage.

If you have a stone in your shoe and it hurts your feet to walk. No matter how much you stretch your foot, when you place your foot back in the shoe, your muscles will instantly tighten up in response to the pain.

Furthermore, when you have painfully contracted muscles protecting the injured area, you also adapt to different movement patterns. This adaptive pattern of incorrect movements only perpetuates the pain of injury through muscular over-contraction causing an increase in joint restriction.

ROM Restriction is a Stability and Motor Control Problem

Every movement of our body is a functionally skilled movement which is controlled by the neuro-muscular system that co-ordinates your joints and soft tissue structures. Simply put, your ability to actively move a joint through a range of motion is not only dictated by the flexibility of the muscles or the mobility at the joint but also by your central nervous system.

Mobility – “What is the restriction?”

Mobility is a correct and intelligent word used by clinicians. When we use the word ‘mobility’, we give a very holistic approach to the problem addressing the stability and mobility control of the body. We look at all the anatomical structures and physiological processes that are possibly affected in the injury process.

So when we say it’s a mobility problem, we address:

Flexibility problems of soft tissue structures.

Movement problems of the joint due to its structural changes.

Motor control problems of the joint due to behavior or protective responses.

Therefore, it is important to recognize that flexibility is crucial but is only one of the components of mobility. There are three solutions to ROM restriction but if we name it as a flexibility problem then there is by definition only one.

Take your finger and pull it back as far as you can safely go, that is flexibility. Now hold your entire finger and the base near the knuckle and circle it in varying ways, the muscles are not stretched but the finger is still moving.

That is improving its mobility, which can influence synovial fluid and joint health.

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No matter what body type you are or the level of activity you do, a good run does wonders. Most of us run for fitness, fun, stress relief or even for a living.

Even the world’s fastest runner, Usain Bolt, will not deny the fact that running is a high impact aerobic exercise and many injuries could be associated with it. Simply put, it is not uncommon for some to experience some sort of aches and pains in your knee after running.

One of the most common knee injury affecting people is “Runner’s Knee”. Though this condition is associated with running, even normal people who engage in knee workouts could be affected by it.

Runner’s Knee- the Mystery behind it

“Runner’s knee” is a term used to describe pain and inflammation in the front of the knee due to several factors. It is mostly believed to be a fault in the biomechanics of your body during the running process.

Biomechanics of running

Biomechanics is the study of the structure and function of body systems when forces are applied.

In simple words, when you run, the foot impact creates a force that transfers upwards to your knees. The force meant to propel you forward is about 2 to 3 times your body weight. To prevent this force from directly impacting your knees, correct posture and placement of your foot is required. Together with coordinated contraction of your leg muscles to balance out these forces.

Injury and pain are believed to occur if there is:

Muscular imbalances, tightness and stiffness around the knee.

Malalignment of your joints affecting the correct heel placement. For example, poor posture or runners with flat or high-arch feet.

Over- activity and weakness in the leg muscles.

How to run safely?

Experts researching on Cheetahs are amazed at their genetics and want to pass along few tips that you could implement.

Tips for humans

Get Good Shoes

Many shoe manufacturers have realized the importance of shoes for performance and have responded by giving us a range of options.

Important things you want to look for:

Light weight shoes for swift movements

Correct fit – snug and supportive

Good arch support

Always Warm-up and Cool-down

Warm-up exercises will prepare the circulatory and respiratory system for the upcoming workout. It also improves the flexibility of your muscles whether it’s just walking or running. On the other hand, cool down exercises help you to gradually lower your heart rate and blood pressure as well as restore the flexibility of your muscles. By skipping them may cause muscle aches and pains after the run.

Maintain the flexibility in your joints, tendons, ligaments and muscles

You want to avoid any restrictions on your movement while running. Improve the range of motion of all the joints and reduce the risk of any muscle strains.

Correct your posture

Poor posture creates imbalances in your muscles and restricts the circulation of blood to them. Over time, it may reduce the oxygen supply which may affect overall health. Therefore, posture is one of the things we try to correct as much as possible.

Prevent Over-striding and Under-striding

Normally you should land with your feet right under you. Over- striding is increasing your stride length over your normal capacity while under-striding is the exact opposite. This happens when you are not bending your knees enough maybe due to tightness in your muscles, joint stiffness and/or poor circulation in your legs.

Watch your Strides- Cadence

Moving with long steps while you run is great! But you may want to consider the number of strides to be maintained about 85-90 per minute with each leg. You could use a digital metronome to record and regulate your strides.

Listen to your body

It will truly help you recognize any restrictions, tightness, faults in your posture that need fixing.

Enrich your brain

You will be amazed how your body adapts to what your brain knows. You can control your body movements and speed just by learning the correct body postures and foot placements.

Maintain good upper and lower body coordination

Muscles work together to cause a movement and running involves co-ordination of your upper and lower limb muscle groups. Any fault in this co-ordination will impose great stress and cause muscle imbalances.

Breathe well

Running being a high impact aerobic exercise requires a great amount of oxygen supply to your muscles to produce energy.

Simple Exercise:

“Diaphragmatic Breathing or Belly breathing”- Breathe deep from your belly, see your stomach rise out as your diaphragm contracts. Practice this technique at rest or while running, it will surely help!

Every person is unique and we need to look at what our body requires. Whether it is tight muscles or faulty posture, you need to fix it before its too late. A safe run is what you want without worrying about injuries, you may want to consider meeting the experts to get a detailed assessment of your body before starting any physical activity.

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Have you ever walked on broken glass? Or experienced walking on a bed of nails? Not something that you would ever wish for yourself or anyone. But this is exactly how you would relate to if you have bad heels. It’s frustrating, extremely painful and debilitating. Many of us who have experienced plantar fasciitis have had the firsthand experience of how the pain takes over your mind and stops your world.

What you need to know?

Heel pain is a symptom and the most common reason why you might have it is because of plantar fasciitis. So what is this difficult-to-pronounce “Plantar fasciitis” (“Plan-ter fash-ee-eye-tus”) all about?

Plantar Fasciitis and heel spurs

Before I explain what plantar fasciitis is, let me provide you with a simple understanding of what your body is made of. Most of us know that our body is made of muscles, tendons, bones, joints and so on. The most overlooked part is “fascia.” Fascia is the largest sensitive band of tissue that covers and cushions each and every internal structure of your body. Kind of like your body’s internal cling film.

Plantar fascia is one such superficial taut band of fascia present beneath the skin on the sole of your foot. This elastic band runs from the heel of your foot to the front of your sole towards your toes, supporting the arches of your foot to distribute your body weight onto your feet. It acts like an inbuilt trampoline with great shock absorbing properties.

So when there is weakness, pain, loss of hydration, inflammation or tear of this fascia, it causes a direct pressure of your body weight onto your heel causing sole pain. Over time, there could be calcium deposits developing underside of your heel bone called “heel spurs” which could be detected via an X-ray.

Are you the reason why you have painful heels?

The exact cause of plantar fasciitis is unknown. However, some of the most common reasons why plantar fasciitis could occur are as follows:

Overuse or micro tear – Fascia damage due to standing for long hours or repeated uphill workouts.

Tight calf muscles – This causing excessive pull and strain to the fascia.

Flat or very high arched feet – This causes the fascia to over-stretch or shorten.

The “Happy feet” Treatment Approach

Because this condition can be quite the challenge to treat and often take a long time to heal, most clinicians are always finding new effective ways treatments methods.

Depending on the extent of injury to your plantar fascia and the time period of your pain (acute or chronic), some of the best drug-free ways to get you back on feet are:

Therapeutic Massage

Different techniques of massage will enhance the blood flow to the fascia and promote healing.

Ice application

Ice application reduces inflammation as it contracts the blood vessels and when combined with massage it will reduce pain, inflammation and promote healing.

Foam Roller

The use of foam roller to bring about a massage-like effect, this relaxes tight calf muscles.

Calf stretches

Although there are several techniques to stretch your calf muscles, one of the simplest one can be done in sitting with legs stretched out. Use a belt or a towel to wrap around the foot and pull it towards your chest holding both ends of the belt or towel. Hold for 30 seconds and relax. Repeat at least 3 times for best results.

Ultrasound therapy

Ultrasound therapy is the use of high-frequency sound waves on injured tissues causing a deep circulatory effect that will enhance tissue healing.

Extracorporeal shockwave therapy

“Extracorporeal” means from outside the body and “shockwave” means a pressure wave. So high energy pressure waves are used on injured tissues to reduce pain and recreate micro-trauma to stimulate the healing process. It is also best used for bone spurs treatment.

Kinesiology Taping

Kinesiology taping is a technique used for applying therapeutic tapes on soft tissues to enhance healing without causing any restriction to joint motion. It will help relax your foot muscles, reduce any swelling and provide support to the arches of your foot.

Corrective shoes, Insoles and Orthotics

An insole provides support to the arches of your foot and helps to correct high or low arches according to your condition. It helps to evenly distribute your body weight on your feet and mostly used as a supplement to wearing good shoes.

Strength training exercises

High-load strength training is the newest approach used for treating plantar fasciitis. It’s simple and just requires you to stand with both your feet on the edge of a stair. You start by letting your affected heel hang over the edge of the stair for 3 seconds followed by raising it up to hold for 2 seconds and then dropping it down again for 3 seconds. Aim for 3 sets of 12 repetitions

It is believed to increase collagen formation that helps normalize tendon structures and improve the load-bearing capacity of the plantar fascia.

Now that you know more about your heel pain and it’s available treatments. It would be wise and worth trying some of them. Though you may not be pain-free overnight, but it will certainly help you heal your heel sooner than you think!

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